Background. The application of volume-controlled high frequency positive pressure ventilation (HFPPV) to the nondependent lung (NL) may have comparable effects to continuous positive airway pressure (CPAP) on the right ventricular (RV) function, oxygenation, and surgical conditions during one lung ventilation (OLV) for thoracotomy. Methods. After local ethics committee approval and informed consent, 75 patients scheduled for elective thoracotomy using OLV were randomly allocated to receive nondependent lung either CPAP 2 (CPAP2; n=25) or 5 (CPAP5; n=25) cm H2O pressure setting of the device or HFPPV using VT 3 mL-1, I: E ratio <0.3 and R.R 60/min (HFPPV; n=25), followed 15 min of OLV. Intraoperative changes in RV ejection fraction (REF), end-diastolic volume (RVEDVI) and stroke work (RVSWI), stroke volume (SVI), oxygen delivery (DO2), and uptake (VO2) indices and shunt fraction (Qs: Qt) were recorded without any surgical manipulation of the lung. Results. The application of NL-HFPPV resulted in improved REF by 33%, SVI and DO2 (P < 0.01) and reduced RVEDVI, RVSWI, PVRI, oxygen uptake, and shunt fraction by 24.8% (P < 0.01) than in the NL-CPAP groups. Conclusion. We concluded that the use of NL-HFPPV is a feasible option and offers improved RV function and oxygenation during OLV for open thoracotomy.
The application of volume controlled high-frequency positive-pressure ventilation (HFPPV) to the non-dependent lung (NL) may have comparable effects to continuous positive-airway pressure (CPAP) on the surgical conditions during one-lung ventilation (OLV) for video-assisted thoracoscopic surgery (VATS). After local Ethics Committee approval and informed consent, we randomly allocated 30 patients scheduled for elective VATS after the first 15 min of OLV to ventilate the NL with CPAP of 2 cm H(2)O (NL-CPAP(2)) and HFPPV using tidal volume 2 ml/kg, inspiratory to expiratory ratio <0.3 and respiratory rate 60/min (NL-HFPPV) for 30 min, each in a randomized crossover order. Intraoperative adequacy of surgical conditions was evaluated using a visual analog scale and the changes in hemodynamic and arterial oxygen were recorded. The application of NL-CPAP(2) and NL-HFPPV resulted in more improved arterial oxygenation than during OLV for VATS (P<0.001). The operative field was much better during the application of NL-CPAP(2) than during NL-HFPPV (P<0.001). We concluded that the application of CPAP to the NL during OLV offers good quality of operative field and improved arterial oxygenation for VATS.
The authors conclude that the use of hypocapnia before and during CO(2) insufflation is effective in attenuating increases in blood pressure after CO(2) pneumoperitoneum during anesthesia for laparoscopic cholecystectomy.
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